Kako se vrniti v vadbene vode po poškodbi

Posted: 20/11/2011 in Poškodbe preventiva in rehabilitacija, Vadba
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Dragi bralci, preljube bralke,

vsi, ki redno trenirate, veste, da poškodbe se dogajajo in se bodo dogajale. Če vas spomnim na uvodne vrstice svojega prejšnjega prispevka Treniranje s poškodbami:

najsi nam je to všeč ali ne, dejstvo je, da so poškodbe del vadbenega procesa. Naj je vaša tehnika še tako brezhibna, naj ste še tako previdni in redno izvajate vaje za mobilnost, stabilnost in fleksibilnost, dejstvo je, da boste slej ko prej (verjetno) utrpeli kakšno poškodbo. Večina teh poškodb bo precej nepomembnih (npr. nategnine ali obtolčenine mišic) in se bodo v zelo kratkem času pozdravile same od sebe, občasno pa se v naše življenje prikrade tudi kakšna resnejša poškodba, ki močno okrni naše vadbene zmožnosti. Kaj storiti v takem primeru?

Pred kratkim sem na strani T-nation našel na to temo odličen članek Step-by-Step Approach to Coming Back from an Injury, v katerem Tim Henriques poda nekaj odličnih nasvetov za postopno (=pametno) vrnitev v vadbene vode po kakršnikoli resnejši poškodbi. In da ne bi po nepotrebnem okolišili, predlagam, da kar začnemo z disekcijo članka

I. Vrste poškodb

Da bi bolje razumeli težave, ki nas pestijo, se je treba nekoliko pomuditi pri bazični terminologiji. Henriques razlike med dvema vrstama poškodb: makropoškodbami (“macrotraumas“) in mikropoškodbami (“microtraumas“).

a. Makropoškodbe

Macrotraumas are sudden, acute injuries; you’ll know the instant they occur. On the court it’s when a point guard comes down with a rebound and snaps his ankle. In our world, it’s when you’re hammering up 315 like it’s styrofoam and something in your pecs pops so loud you can hear it over the Lady Gaga playing on the sound system.

That’s macrotrauma. Specific examples include fractures, dislocations, sprains (injuries to ligaments), strains (injuries to muscles and tendons), deep lacerations, and very serious contusions.

Tole, denimo, bi bil primer makropoškodbe:

 

Gre za precej odmevno poškodbo Madžara Janosa Baranyaija iz olimpijskih iger l. 2008 v Beijingu. V primeru, da ste prezrli bistveno:

Skratka, če v delu vašega telesa nekaj “poči” in je vaša reakcija podobna Janosovi, reakcija mimoidočih pa je približno takšna:

potem ste lahko prepričani, da gre za makropoškodbo. 😉

b. Mikoropoškodbe

To so tiste nadležne male bolečinice, ki se pojavljajo znova in znova ter kar nočejo in nočejo izginiti, dokler (občasno) ne postanejo tako prominentne, da vas prisiljo v počitek in rehabilitacijo.

A microtrauma is a chronic overuse injury. Although less dramatic from an athlete’s point of view, microtraumas can be just as annoying as they’re often difficult to properly assess and manage.

Examples of microtraumas include stress fractures and tendonitis (some prefer the term tendinosis), with tennis elbow and golfer’s elbow being common afflictions.

It’s very common for these injuries to linger, sometimes for months, and rest doesn’t automatically heal them, adding to the frustration. Nothing’s worse than taking a month off from lifting to let an injury heal and upon returning realizing that, a) you’re now weak as shit and, b) you still have the injury to deal with. It’s enough to make some give up on training altogether!

II. Odziv telesa na poškodbo

Henriques navaja tri faze, skozi katere gre telo, kadar utrpi takšno ali drugačno poškodbo. Pri tem je najpomembnejša tale misel:

You can’t skip steps – you must complete one phase before moving on to the next, no matter how badly you want to rush it.

To je nauk, ki si ga velja zapisati v srce in razum z debelimi črkami, tako da ko vas bo naslednjič zasrbelo, da poprimete za težke uteži takoj, ko se boste počutili le malo bolje, čeprav poškodba še ne bo dokraja zaceljena, s čimer boste svoje telo le pahnili nazaj na začetno fazo – takrat torej si prisolite eno tako konkretno zaušnico (ali pak – če ne premorete samodiscipline za takšen ukrep – poprosite kakega dobrega kamerada, da to stori v vašem imenu), kot jo denimo dodeli spodnja kodrolaska (te so vűn z vroga!) svojemu mlajšemu bratcu:

Pa naj še kdo poreče, da slovenski filmi niso zanimivi! 🙂

Sedaj pa k posamičnim fazam:

1. Prva (vnetna) faza (do pribl. 2 tednov)

Glavno pravilo v tej fazi je, da prizadeto mesto miruje (beri: ne rovli po toten blati (=poškodbi)!):

The first phase is the inflammation phase. This happens immediately (within minutes) of a serious injury and can last from several days to a couple of weeks for more serious injuries. During this phase the injured area swells up; it will likely be red, hot, may throb, and it will hurt even if the area isn’t moved.

You can train unaffected areas if it doesn’t bother the injured area, but the training goal for the injured area is simple: don’t make the injury worse. That means leave it the hell alone! Don’t train it lightly, don’t stretch it (unless instructed by a doctor), and don’t go for a light jog instead of a hard run. Just leave it alone. (!)

You can also RICE the injured area. RICE stands for Rest (leave it alone), Ice (ice for 15-20 minutes an hour, as often as possible), Compression (wrap it up loosely), and Elevation (put it above the heart if possible when at rest).

To summarize, perform no training for the injured area. This sucks, but this phase only lasts about two weeks.

2. Druga (okrevalna) faza (do dveh mescev – pri najhujših poškodbah)

Glavno pravilo: preprečitev atrofije. Višji rang ponovitev, lažje teže, izvajanje gibov do bolečine; ogibljemo se večjim težam in eksplozvnim gibom:

Once the inflammation has subsided (the swelling reduced and the pain at rest diminished), the body enters the second phase of injury, the repair phase.

As the name implies, the body is now trying to repair the injury, but now the body is in quick fix mode. It wants to repair the injury as quickly as possibly to allow basic functioning to return.

(…)

During the repair phase the body is using collagen tissue to fix the injury, which is a bit like the body’s version of duct tape. However, at this time the body is laying that collagen tissue down in a haphazard fashion.

This is extremely important for the lifter to remember. The body is attempting to return to basic functioning during this phase, nothing more. But problems occur when the lifter starts to feel better and, eager to return to their previous activities, tries to push it or “test it.” All too often the result is the area gets re-injured and the entire process must start all over again. (!!!khm, spomnimo se zgoraj omenjene zaušnice!!!)

During this phase, the training goal is to prevent atrophy (muscle loss) of the injured area. The good news is that this is much easier to accomplish than creating hypertrophy (building muscle), as basic stimulation will prevent atrophy.

Training guidelines for this phase including focusing on a pain-free range of motion, even if it’s limited in the beginning. Isometrics are a useful tool; one can start in a pain-free ROM and then gradually increase it over time.

Slow speed, light-weight resistance training can be used as well, with 10-20 reps being the norm; be sure to err on the side of light weight and high reps in this phase. Open chained and isolation movements are preferred for introducing load to the injured area.

Lifters should also focus on stretching to get back any flexibility that was lost from the injury, with the goal of a return to a normal level of flexibility if possible. The lifter might also start to work on stability in a controlled setting near the end of this phase. Heavy weights should definitely be avoided (stay with <50% 1RM), along with any high speed, high power, or explosive movements.

Typically the repair phase lasts about two months from the end of the inflammation phase for most reasonably serious injuries. The lifter can and should work on other areas of the body or components of fitness not limited by the injury.

3. Tretja (obnovitvena) faza (do 4 mesce)

Glavno pravilo: postopen (!) – linearen – povratek na prejšnjo raven delovanja (in nato – seveda – še dlje! ;)):

The final phase in injury is the remodeling phase, which usually lasts 2-4 months from the end of the repair phase. (…) Collagen fibers are laid down now in an organized fashion and strength and stability should return over time to the injured area. By the beginning, or certainly the middle of this phase, most ROM should’ve returned to the injured area, which is important to monitor as continued limitations in ROM might become permanent if not addressed during this phase.

The training goal for this phase is a “return to previous level and beyond.” As the body begins to get stronger, heavier weights (>50% 1RM) can be used, although do NOT rush into them. (!!!bitch-slap much?!!!)

Furthermore, a lifter must realize after being hurt, followed by several months of low intensity activity, that their 1RM is not what it once was. The safest bet is to return to the weights at the end of the repair phase but follow a linear progression of slowly increasing the weights by 5 or 10 lbs. a week for as long as possible.

Closed chain, compound movements can now be gradually incorporated into the program. More explosive movements can also be employed; a good goal is to have the injured area be at least 90% as strong as the non-injured area before including high speed power movements in the program. If any proprioception was lost during the injury, that type of work should be included as well.

III. Zaključek

Še nekaj zaključnih misli:

  • Getting injured sucks the big one, but all is not lost. Once the injury has been properly diagnosed and treated, sit down with your doctor and set a realistic time line for when you think you will be better.
  • Then, be conservative. Work slowly toward that timeline and be patient, as most big injuries take at least six months to return to near normal.
  • You could even use this time as a gift, although it won’t feel like a gift when you’re mired in the middle of it. See it as a chance to return to the basics, like mastering your form on the big exercises you can safely perform. Read more, work on your weak points, and build all the components of fitness. (…) I dislocated my shoulder my senior year of high school playing football and while it sucked to sit out my senior year, I used that time to learn more about fitness and how the body works. That was one of the first steps that led me to a career in fitness, which I’m happy to have today.

O tem, da so lahko poškodbe tudi zelo koristne, sem pisal že tudi v uvodu omenjenem članku Treniranje s poškodbami;  poškodbe so lahko koristne na vsaj treh ravneh:

a. Dejstvena (faktična) raven: če si vzamemo čas in se izobrazimo o lastni poškodbi, se lahko veliko naučimo o anatomiji našega telesa ter o (bio)mehaniki posamičnih gibov;

b. Pragmatična raven: poškodbe so velikokrat dober pokazatelj, da je z našo vadbo nekaj narobe, in nam dajejo odlično priložnost, da premislimo svoje pomanjkljivosti in šibke točke ter jih začnemo odpravljati; velikokrat se izkaže, da so glavni vzroki za naše poškodbe nesorazmerja v mobilnosti, stabilnosti in fleksibilnosti, stvareh, ki jim veliko športnikov namenja vse premalo pozornosti (jup, to je tista “dolgočasna” reč, ki jo počnete pred in po “pravi stvari”). 

c. Bivanjska raven (hehe, že vidim, kako eni obračate z očmi: “Here we go again…”): but srysly, poškodbe – če so le dovolj resne – nas prisilijo, da premislimo, zakaj vadimo: kaj so naši glavni cilji in kaj želimo z vadbo sploh doseči (o svojih pogledih na to, kaj je pri vadbi res najpomembnejše, sem podrobneje pisal v prispevku Tisto najpomembnejše); so tudi odlična priložnost za preizpraševanje naših temeljnih vrednot in vadbene etike ter za krepitev vrlin, kot so potrpežljivost, ponižnost in nenavezanost. Pokažejo tudi, iz kakšnega testa si – boš vrgel puško v koruzo in se vdal v usodo ali skušal najti načine, kako bi se iz tega pripetljaja čim več naučil.

Kot zaključi Henriques:

Bottom line is, life will be good again. Use the mental toughness and determination that lifting has developed in you and apply that to your injury. Remain positive; remember those that helped you out, and you may just come out on the other side stronger and healthier than ever before.

Ali če se ponovno obrnemo k dobremu staremu Epiktetu:

“Vsi dogodki so v vaše dobro – če se ga le potrudite najti!”

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Komentarji
  1. M. pravi:

    Jah, kako? Greš, pa si zdrav! 😉

  2. Luka pravi:

    Hvala

  3. PostaniAtlet pravi:

    Dej pridi v utežarno rajši kaj 🙂

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